Appendix B: FORMS WRITTEN TEST Please select True or False: 1. The person administering the protocol in the event of a life-threatening breathing emergency may choose to only give the EpiPen or nebulized albuterol. 2. An EpiPen should only be used if the student has stopped breathing. 3. While following the protocol, if the victim stops breathing, ERT members will assess for an open airway and, if present, begin CPR. Please choose one answer for each question: 4. Which of the following statements is about EpiPen administration? a) The preferred site of administration is the upper arm muscle. b) The used EpiPen should be given to EMS personnel when student is transported to emergency medical facility. c) It cannot be administered through clothing. d) When administering, press hard and hold in place for 60 seconds. 5. Which of the following statements is about the protocol standing order? a) Use the EpiPen Jr for a student weighing more than 100 lbs. b) Administer nebulized albuterol followed by the EpiPen. c) Administer EpiPen followed by nebulized albuterol. d) Nebulized albuterol may only be administered once. 6. Which of the following is about the use of nebulized albuterol when initiating the protocol during an anaphylactic reaction? a) If the student weighs less than 50 lbs, use half the albuterol dose. b) The albuterol treatment should only be administered once. c) It is not necessary to call 911 if the student feels better after administering the protocol. d) Administer the albuterol treatment immediately after using the EpiPen. 7. Which of the following are NOT signs or symptoms of an asthma/anaphylaxis emergency? a) Chest tightness, wheezing, severe shortness of breath causing speech In 1-2 word phrases, or complete inability to speak b) Dilated pupils, hallucinations, or headache c) Retractions (chest or neck sucked in), cyanosis (lips or nail beds exhibiting gray or bluish color), hunched over position d) Change in mental status: apprehension, anxiety, restlessness, irritability
8. Daniel, a 10 yr old student diagnosed with asthma, enters the (health) office and states that he feels a little wheezy. This student has an asthma action plan and personal medications at school. Which of the following would you do FIRST? a) Have him lay down on a cot. b) Call his parent/guardian. c) Let him use his quick-relief inhaler according to his action plan. d) Offer a drink of water. 9. Sophie, a 14 yr old student, enters the (health) office and states she ate a cookie and she feels like her mouth is swelling. She is very short of breath and gasping for air. She doesn t have a personalized allergy action plan or medications at school. According to the Rule 59 protocol, which of the following would you do FIRST? a) Call 911 b) Call her physician c) Check her mouth d) Have someone get the cookie package 10. The Rule 59 medications (EpiPen, albuterol) found in the portable emergency container a) Can be given to a student if the parent requests b) Can be used if parents supply tubing for albuterol c) Are only to be used for life-threatening breathing emergencies d) Can go on field trips 11. Identify the five (5) R's for administering medication. a) b) c) d) e) 12. Select the two choices below that describe the desired action of an EpiPen. Enable the victim to relax and sleep Reverse the body's reaction to an antigen Help the body to eliminate excess fluid Reduce swelling and congestion in the lungs 13. Select the two choices below that describe the desired action of albuterol. Relaxes tightened muscles around the airways Increases heart rate Opens airways to ease breathing Reduces nausea and anxiety 14. Which two of the following must be verified prior to EpiPen administration? a) Check student health file for history of asthma/allergies b) Check window in EpiPen for color, clarity, and crystallization of medication c) Check to see if victim is breathing d) Check to see if victim appears to weigh more or less than 50 lbs to determine which dose of epinephrine to administer (EpiPen, EpiPen Jr.)
Answers to Written Test Please select True or False: 1. The person administering the protocol in the event of a life-threatening breathing emergency may choose to only give the EpiPen or nebulized albuterol. 2. An EpiPen should only be used if the student has stopped breathing. 3. While following the protocol, if the victim stops breathing, ERT members will assess for an open airway and, if present, begin CPR. Please choose one answer for each question: 4. Which of the following statements is about EpiPen administration? (b) The used EpiPen should be given to EMS personnel when student is transported to emergency medical facility. 5. Which of the following statements is about the protocol standing order? (c) Administer EpiPen followed by nebulized albuterol. 6. Which of the following is about the use of nebulized albuterol when initiating the protocol during an anaphylactic reaction? (d) Administer the albuterol treatment immediately after using the EpiPen. 7. Which of the following are NOT signs or symptoms of an asthma/anaphylaxis emergency? (b) Dilated pupils, hallucinations or headache 8. Daniel, a 10 yr old student diagnosed with asthma, enters the (health) office and states that he feels a little wheezy. This student has an asthma action plan and personal medications at school. Which of the following would you do FIRST? (c) Let him use his quick-relief inhaler according to his action plan
Answers to Written Test continued 9. Sophie, a 14 yr old student, enters the (health) office and states she ate a cookie and she feels like her mouth is swelling. She is very short of breath and gasping for air. She doesn t have a personalized allergy action plan or medications at school. According to the Rule 59 protocol, which of the following would you do FIRST? (a) Call 911 10. The Rule 59 medications (EpiPen, albuterol) found in the portable emergency container (c) Are only to be used for life-threatening breathing emergencies 11. Identify the five (5) R's for administering medication. Right Person Right Medication Right Dose Right Time Right Route 12. Select the two choices below that describe the desired action of an EpiPen. Enable the victim to relax and sleep X Reverse the body's reaction to an antigen Help the body to eliminate excess fluid X Reduce swelling and congestion in the lungs 13. Select the two choices below that describe the desired action of albuterol. X Relaxes tightened muscles around the airways Increases heart rate X_ Opens airways to ease breathing Reduces nausea and anxiety 14. Which two of the following must be verified prior to EpiPen administration? (b) Check window in EpiPen for color, clarity, and crystallization of medication (d) Check to see if victim appears to weigh more or less than 50 lbs to determine which dose of epinephrine to administer (EpiPen, EpiPen Jr.) Trainers Please note the passing percentage of 80%, at least 11 questions answered correctly.